Summary ATI Peds Proctored Exam Complete Study Guide – Latest Fall 2026/2027 |
ATI Pediatrics Nursing Proctored Exam Review | Pediatric Nursing Study Guide |
Growth & Development, Family-Centered Care, Pediatric Assessment, Vital Signs,
Newborn & Infant Care, Respiratory Disorders, Cardiovascular Disorders,
Gastrointestinal Disorders, Neurologic Conditions, Endocrine Disorders, Infectious
Diseases, Medication Administration, Pediatric Emergencies, Safety & Clinical
Judgment | Practice Questions, Answers & Detailed Rationales
Question 1: A 4-year-old child with a history of asthma is brought to the emergency
department with a respiratory rate of 40 breaths per minute, nasal flaring, and intercostal
retractions. Which assessment finding is the most indicative of an impending respiratory
failure?
A. Audible expiratory wheezing
B. Oxygen saturation of 92% on room air
C. A silent chest on auscultation
D. A peak expiratory flow rate of 75% of personal best
CORRECT ANSWER: C. A silent chest on auscultation
Rationale: A silent chest in a child experiencing an asthma exacerbation is a critical sign
indicating severe airway obstruction and decreased air movement. This is a sign of impending
respiratory failure, as it suggests that the airways are so constricted that airflow is minimal,
making wheezing inaudible. In contrast, audible wheezing indicates some air movement and is
often heard earlier in the exacerbation.
Question 2: A 6-month-old infant is admitted with bronchiolitis caused by RSV. Which nursing
intervention is the highest priority for this infant?
A. Administering a bronchodilator as prescribed
B. Maintaining strict intake and output
C. Administering antibiotics to prevent secondary infection
D. Monitoring for signs of respiratory distress and suctioning as needed
CORRECT ANSWER: D. Monitoring for signs of respiratory distress and suctioning as needed
Rationale: The priority for an infant with RSV bronchiolitis is maintaining a patent airway and
supporting respiratory function. Infants are obligate nose breathers, and nasal congestion can
significantly compromise their breathing. Therefore, frequent monitoring for distress and nasal
suctioning are the most immediate and critical interventions to prevent respiratory failure.
Question 3: A 2-year-old child who is a known asthmatic is receiving albuterol via a nebulizer.
What is the most important parameter to monitor during and after this treatment?
,A. Heart rate
B. Blood pressure
C. Respiratory rate
D. Temperature
CORRECT ANSWER: A. Heart rate
Rationale: Albuterol is a beta-2 adrenergic agonist that can stimulate beta-1 receptors in the
heart as a side effect, leading to tachycardia. This is particularly important to monitor in a
young child to prevent complications. While respiratory rate and oxygen saturation are also
assessed, tachycardia is a direct and specific adverse effect of the medication that requires
immediate monitoring.
Question 4: The nurse is providing education to the parents of a 2-month-old infant who is
prescribed palivizumab. Which statement by the parent indicates a need for further teaching?
A. "My baby will get this vaccine to help prevent RSV."
B. "We will need to bring him in for this shot every month during RSV season."
C. "This medication is not a treatment for RSV, but a preventative measure."
D. "He will only need this for this one RSV season."
CORRECT ANSWER: A. "My baby will get this vaccine to help prevent RSV."
Rationale: Palivizumab is a monoclonal antibody, not a vaccine. It provides passive immunity
against RSV and is administered as a series of injections to high-risk infants during RSV season.
It does not stimulate the body's immune system to produce antibodies like a vaccine; therefore,
referring to it as a vaccine shows a misunderstanding.
Question 5: A school-age child is prescribed methylphenidate for ADHD. Which side effect
should the nurse instruct the parents to monitor for most closely?
A. Increased appetite
B. Decreased heart rate
C. Weight loss and insomnia
D. Sedation and lethargy
CORRECT ANSWER: C. Weight loss and insomnia
Rationale: Methylphenidate is a CNS stimulant. Its common side effects include decreased
appetite, insomnia, and weight loss. Parents should be taught to monitor the child's nutritional
intake and sleep patterns closely. The nurse may also recommend administering the medication
before meals and adjusting the last dose of the day to be earlier to minimize insomnia.
,Question 6: A child with a diagnosis of cystic fibrosis is prescribed pancreatic enzymes. When
should the nurse teach the parents to administer these enzymes?
A. Once a day in the morning before breakfast
B. With all meals and large snacks
C. Only when the child experiences abdominal pain
D. At bedtime to ensure absorption overnight
CORRECT ANSWER: B. With all meals and large snacks
Rationale: Pancreatic enzymes should be administered with all meals and snacks to facilitate
the digestion of fats, proteins, and carbohydrates. They must be given immediately before or
with the first bite of food to ensure they mix with the chyme in the small intestine and replace
the deficient pancreatic enzymes.
Question 7: The nurse is assessing a 3-year-old child with a suspected urinary tract infection.
Which symptom is most commonly seen in this age group?
A. Flank pain
B. Enuresis
C. Gross hematuria
D. Fever and vomiting
CORRECT ANSWER: D. Fever and vomiting
Rationale: In children under 5 years of age, UTIs often present with non-specific symptoms such
as fever, vomiting, poor feeding, and abdominal pain. While enuresis can be a sign, it is more
common in older children. Fever and vomiting are classic signs in toddlers and preschoolers
that indicate a systemic response to the infection.
Question 8: A 14-year-old adolescent with type 1 diabetes is feeling shaky, diaphoretic, and
has a blood glucose level of 55 mg/dL. What is the initial nursing action?
A. Administer subcutaneous glucagon
B. Give 4 ounces of orange juice
C. Call the healthcare provider immediately
D. Administer regular insulin per sliding scale
CORRECT ANSWER: B. Give 4 ounces of orange juice
, Rationale: This adolescent is displaying signs of hypoglycemia. The initial treatment is to
provide a rapid-acting source of glucose, such as 4-6 ounces of fruit juice, regular soda, or
glucose tablets. This will raise blood glucose quickly. Glucagon is indicated if the patient is
unconscious or unable to swallow safely.
Question 9: A 10-year-old child is to receive a blood transfusion of packed red blood cells.
Before hanging the blood, what is the most important action for the nurse to take?
A. Check the child's vital signs, including temperature.
B. Ensure the blood has been warmed to room temperature for 30 minutes.
C. Verify the blood product with another licensed nurse using a two-person verification process.
D. Prime the IV tubing with normal saline.
CORRECT ANSWER: C. Verify the blood product with another licensed nurse using a two-
person verification process.
Rationale: The two-person verification process is the most critical safety step in blood
administration to prevent transfusion errors. The two licensed nurses must verify the patient's
identity (name and ID number), the blood type and Rh factor, the unit number, and the
expiration date against the patient's chart and blood band.
Question 10: A 5-year-old child is postoperative day 1 following a tonsillectomy. The child's
mother reports that the child is swallowing frequently. What is the nurse's priority action?
A. Offer the child some ice chips.
B. Assess the child's heart rate and blood pressure.
C. Inspect the child's throat and assess for vomiting of bright red blood.
D. Administer prescribed pain medication.
CORRECT ANSWER: C. Inspect the child's throat and assess for vomiting of bright red blood.
Rationale: Frequent swallowing after a tonsillectomy can be a sign of bleeding from the surgical
site. The nurse's priority is to inspect the throat and assess for bleeding, which could manifest
as bright red emesis or persistent swallowing of blood. This is a post-operative emergency that
requires immediate evaluation.
Question 11: A 6-month-old infant is brought to the clinic for a well-child visit. The infant's
birth weight was 7 lbs. The nurse expects the infant's current weight to be approximately:
A. 10 lbs
B. 14 lbs
ATI Pediatrics Nursing Proctored Exam Review | Pediatric Nursing Study Guide |
Growth & Development, Family-Centered Care, Pediatric Assessment, Vital Signs,
Newborn & Infant Care, Respiratory Disorders, Cardiovascular Disorders,
Gastrointestinal Disorders, Neurologic Conditions, Endocrine Disorders, Infectious
Diseases, Medication Administration, Pediatric Emergencies, Safety & Clinical
Judgment | Practice Questions, Answers & Detailed Rationales
Question 1: A 4-year-old child with a history of asthma is brought to the emergency
department with a respiratory rate of 40 breaths per minute, nasal flaring, and intercostal
retractions. Which assessment finding is the most indicative of an impending respiratory
failure?
A. Audible expiratory wheezing
B. Oxygen saturation of 92% on room air
C. A silent chest on auscultation
D. A peak expiratory flow rate of 75% of personal best
CORRECT ANSWER: C. A silent chest on auscultation
Rationale: A silent chest in a child experiencing an asthma exacerbation is a critical sign
indicating severe airway obstruction and decreased air movement. This is a sign of impending
respiratory failure, as it suggests that the airways are so constricted that airflow is minimal,
making wheezing inaudible. In contrast, audible wheezing indicates some air movement and is
often heard earlier in the exacerbation.
Question 2: A 6-month-old infant is admitted with bronchiolitis caused by RSV. Which nursing
intervention is the highest priority for this infant?
A. Administering a bronchodilator as prescribed
B. Maintaining strict intake and output
C. Administering antibiotics to prevent secondary infection
D. Monitoring for signs of respiratory distress and suctioning as needed
CORRECT ANSWER: D. Monitoring for signs of respiratory distress and suctioning as needed
Rationale: The priority for an infant with RSV bronchiolitis is maintaining a patent airway and
supporting respiratory function. Infants are obligate nose breathers, and nasal congestion can
significantly compromise their breathing. Therefore, frequent monitoring for distress and nasal
suctioning are the most immediate and critical interventions to prevent respiratory failure.
Question 3: A 2-year-old child who is a known asthmatic is receiving albuterol via a nebulizer.
What is the most important parameter to monitor during and after this treatment?
,A. Heart rate
B. Blood pressure
C. Respiratory rate
D. Temperature
CORRECT ANSWER: A. Heart rate
Rationale: Albuterol is a beta-2 adrenergic agonist that can stimulate beta-1 receptors in the
heart as a side effect, leading to tachycardia. This is particularly important to monitor in a
young child to prevent complications. While respiratory rate and oxygen saturation are also
assessed, tachycardia is a direct and specific adverse effect of the medication that requires
immediate monitoring.
Question 4: The nurse is providing education to the parents of a 2-month-old infant who is
prescribed palivizumab. Which statement by the parent indicates a need for further teaching?
A. "My baby will get this vaccine to help prevent RSV."
B. "We will need to bring him in for this shot every month during RSV season."
C. "This medication is not a treatment for RSV, but a preventative measure."
D. "He will only need this for this one RSV season."
CORRECT ANSWER: A. "My baby will get this vaccine to help prevent RSV."
Rationale: Palivizumab is a monoclonal antibody, not a vaccine. It provides passive immunity
against RSV and is administered as a series of injections to high-risk infants during RSV season.
It does not stimulate the body's immune system to produce antibodies like a vaccine; therefore,
referring to it as a vaccine shows a misunderstanding.
Question 5: A school-age child is prescribed methylphenidate for ADHD. Which side effect
should the nurse instruct the parents to monitor for most closely?
A. Increased appetite
B. Decreased heart rate
C. Weight loss and insomnia
D. Sedation and lethargy
CORRECT ANSWER: C. Weight loss and insomnia
Rationale: Methylphenidate is a CNS stimulant. Its common side effects include decreased
appetite, insomnia, and weight loss. Parents should be taught to monitor the child's nutritional
intake and sleep patterns closely. The nurse may also recommend administering the medication
before meals and adjusting the last dose of the day to be earlier to minimize insomnia.
,Question 6: A child with a diagnosis of cystic fibrosis is prescribed pancreatic enzymes. When
should the nurse teach the parents to administer these enzymes?
A. Once a day in the morning before breakfast
B. With all meals and large snacks
C. Only when the child experiences abdominal pain
D. At bedtime to ensure absorption overnight
CORRECT ANSWER: B. With all meals and large snacks
Rationale: Pancreatic enzymes should be administered with all meals and snacks to facilitate
the digestion of fats, proteins, and carbohydrates. They must be given immediately before or
with the first bite of food to ensure they mix with the chyme in the small intestine and replace
the deficient pancreatic enzymes.
Question 7: The nurse is assessing a 3-year-old child with a suspected urinary tract infection.
Which symptom is most commonly seen in this age group?
A. Flank pain
B. Enuresis
C. Gross hematuria
D. Fever and vomiting
CORRECT ANSWER: D. Fever and vomiting
Rationale: In children under 5 years of age, UTIs often present with non-specific symptoms such
as fever, vomiting, poor feeding, and abdominal pain. While enuresis can be a sign, it is more
common in older children. Fever and vomiting are classic signs in toddlers and preschoolers
that indicate a systemic response to the infection.
Question 8: A 14-year-old adolescent with type 1 diabetes is feeling shaky, diaphoretic, and
has a blood glucose level of 55 mg/dL. What is the initial nursing action?
A. Administer subcutaneous glucagon
B. Give 4 ounces of orange juice
C. Call the healthcare provider immediately
D. Administer regular insulin per sliding scale
CORRECT ANSWER: B. Give 4 ounces of orange juice
, Rationale: This adolescent is displaying signs of hypoglycemia. The initial treatment is to
provide a rapid-acting source of glucose, such as 4-6 ounces of fruit juice, regular soda, or
glucose tablets. This will raise blood glucose quickly. Glucagon is indicated if the patient is
unconscious or unable to swallow safely.
Question 9: A 10-year-old child is to receive a blood transfusion of packed red blood cells.
Before hanging the blood, what is the most important action for the nurse to take?
A. Check the child's vital signs, including temperature.
B. Ensure the blood has been warmed to room temperature for 30 minutes.
C. Verify the blood product with another licensed nurse using a two-person verification process.
D. Prime the IV tubing with normal saline.
CORRECT ANSWER: C. Verify the blood product with another licensed nurse using a two-
person verification process.
Rationale: The two-person verification process is the most critical safety step in blood
administration to prevent transfusion errors. The two licensed nurses must verify the patient's
identity (name and ID number), the blood type and Rh factor, the unit number, and the
expiration date against the patient's chart and blood band.
Question 10: A 5-year-old child is postoperative day 1 following a tonsillectomy. The child's
mother reports that the child is swallowing frequently. What is the nurse's priority action?
A. Offer the child some ice chips.
B. Assess the child's heart rate and blood pressure.
C. Inspect the child's throat and assess for vomiting of bright red blood.
D. Administer prescribed pain medication.
CORRECT ANSWER: C. Inspect the child's throat and assess for vomiting of bright red blood.
Rationale: Frequent swallowing after a tonsillectomy can be a sign of bleeding from the surgical
site. The nurse's priority is to inspect the throat and assess for bleeding, which could manifest
as bright red emesis or persistent swallowing of blood. This is a post-operative emergency that
requires immediate evaluation.
Question 11: A 6-month-old infant is brought to the clinic for a well-child visit. The infant's
birth weight was 7 lbs. The nurse expects the infant's current weight to be approximately:
A. 10 lbs
B. 14 lbs
